- Strong fear of weight gain
- Continued behavior that prevents necessary weight gain
- Limit of food intake that leads to a considerably low body weight
- Persistent lack of recognition of the seriousness of low body weight
Subtypes include the restricting type of anorexia, which describes a presentation where weight loss is accomplished through diet, exercise and fasting, as well as the binge eating/purging type (a separate diagnosis from bulimia). For both of the subtypes, the time period considered for diagnosis is a three-month window.
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Eating Disorders: A Complex Picture
The National Institute of Mental Health (NIMH) reports a lifetime prevalence of 0.6 percent for anorexia in the US and a lifetime prevalence of females at 0.9 percent versus 0.3 percent for males. For age, there was no significantly different lifetime rates for those 18-60 and older.
NIMH also found that the average age of onset is 19 years old. Lifetime treatment rates for anorexia show that 33.8 percent of those with the disorder receive care. According to these statistics, it is discouraging to think that there is a substantial amount (approximately 67 percent) that do not get the help they need.
Many in society think of eating disorders as affecting primarily females. However, according to the National Association of Males with Eating Disorders, 25 percent of those diagnosed with an eating disorder are male. Thus, they assert that attention to gender dynamics is essential to the treatment process.
The National Eating Disorders Association reports that almost 50 percent of those with an eating disorder are also abusing substances, which is a rate five times greater than that seen in the general population. In addition, NEDA points out that substance abuse can come on at any time, whether it be before, during, or after treatment of an eating disorder. This underscores the need for proper support and treatment protocols that will allow individuals with these co-occurring conditions to reclaim their lives.
Co-Occurring Anorexia and Addiction
In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a comprehensive advisory regarding co-occurring substance abuse and eating disorders. Their findings were comprehensive with regard to diagnosis, treatment options, and sustained recovery. They found that eating disorders (EDs) frequently co-occur with substance use disorders (SUDs), and that treatment of both concurrently is very challenging. SAMHSA reports that 14 percent of women with an SUD have bulimia and 14 percent had anorexia. Further, as EDs become more intense, there was an increase in the number of substances used.
It is common for people with SUDs to self-medicate, especially after recovery. After achieving recovery, it is as if a coping mechanism has been removed, whether it be the substance or the eating disorder.
Eating disorders, especially anorexia, have a strong association with mental health disorders. For example, in its advisory, SAMHSA reports a close correlation between anorexia and MDD (major depressive disorder), narcissistic personality disorder, and bipolar II disorder. The same is true with bulimia, which has a strong association with bipolar II disorder. Both anorexia and bulimia are often diagnosed with borderline personality disorder.
Helping a Loved One with Anorexia
It is very difficult for family and friends to watch a loved one struggle with what could become a terminal illness. What begins as food avoidance progresses to outright starvation. The weight loss becomes substantial, their physical appearance changes, and they are clearly quite ill. They may deny and argue when faced when the assertion that they are too thin. It is possible to facilitate treatment. Oftentimes, an intervention is helpful.
An intervention is a meeting led by a mental health professional known as an interventionist. The interventionist can help to facilitate discussion and assist with setting the right tone for the conversation. Basically, the person’s loved ones gather in a private location with prepared talking points or scripted remarks, which they take turns reading. Another friend or family member will bring the person to the site, at which time they will hear the personal stories of each participant. This is a tough meeting for everyone involved, but hearing how their self-harm is affecting their family and friends can motivate the person to seek treatment. Giving up their sense of control over their bodies and their eating habits can be especially difficult for a person with an eating disorder.
Treatment of Anorexia and Addiction
Those suffering from anorexia or other weight control behaviors are more likely to abuse drugs, according to the National Institute on Drug Abuse (NIDA), based on an article in the International Journal of Eating Disorders. Of the more than 10,000 teens who participated in the Youth Risk Behavior Surveillance System, 10 percent of boys and 20 percent of girls reported unhealthy weight control behaviors in the previous month. In treating co-occurring SUDs and EDs, in some cases, it is recommended that the SUD be treated first in the event that the treatment is not able to address both disorders. Most standalone eating disorder treatment facilities are not equipped to treat someone with an active substance use disorder; however, some facilities will be able to treat both conditions simultaneously.
Anorexia can be life-threatening. Inpatient treatment is usually recommended for anorexia in order to slowly facilitate weight gain. It is important that this process happen gradually because the individual may at first be alarmed when they see that their weight is increasing. This is very disturbing for many with anorexia, as they feel a loss of control when their food situation is suddenly being managed by someone else, such as a medical doctor. In an inpatient setting, the person can receive a wide range of treatment modalities, such as
- Individual psychotherapy
- Nutrition counseling
- Cognitive Behavioral Therapy (CBT)
- Support groups
- Family therapy
Individual psychotherapy provides the person with their own therapist with whom they can speak confidentially and talk through issues as well as how to succeed once they are discharged. Nutrition counseling allows them to meet with a dietician to develop healthy eating habits that can sustain them post treatment.
The purpose of CBT is based on the premise that thoughts and feelings influence behavior. If these thoughts are flawed and/or illogical, they may cause emotional disturbances and negative behaviors. Eating disorders are especially suited for CBT, as so much of the disorder is based on a distortion of the person’s body image (a flawed perception). A therapist trained in CBT can work with the individual by helping them identify negative thought patterns, work through their roots, and give the individual new tools to manage their illness.
Nutrition counseling is key to helping the individual transition to a diet focused on making healthier choices. It’s important that a person with an eating disorder feels empowered, which is different than the element of control or the methods they used to restrict food and caloric intake. A dietician can educate the individual about both general nutrition and concepts that are specific to recovery from an eating disorder. They may also monitor weight gain or loss, but should make that decision carefully within the context of their ongoing relationship with the client.
Support groups can be an excellent way for those with eating disorders to connect with peers on a different level than in other types of relationships. These groups allow participants to learn from others who have been in, and currently are in, their shoes. They provide an invaluable source of support for those in recovery from both anorexia and substance abuse.
Family therapy can be very effective in repairing relationships that have been damaged by the eating disorder or ongoing addiction. Under direction from a therapist, the client can talk with their family, and together, they may identify environmental triggers or activities that could invoke previous habits that may endanger their health.
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Treating a substance use disorder and anorexia requires prompt, closely monitored care. Just as eating disorders are driven by control and body image issues, substance use lowers inhibition and can lead to addiction. For example, a binge-purge subtype of anorexia may not enjoy the process of bingeing and purging but deems it necessary. When you add a substance, the process may become more pleasurable (or less dreadful) due to the relaxation that the substance brings. The person gets used to that buffer, and the things they do to manage their weight become easier. Likewise, a person with a substance use disorder may try extreme dieting and use the substance of abuse to stave off hunger and experience pleasure. The substance use disorder and anorexia complement each other, causing the person to spiral deeper into each disorder.
Despite the strong grip that anorexia and addiction can have on a person, there is hope for full recovery. Both addiction and anorexia can be treated with a skilled team of professionals. Because of the medical implications, these individuals are usually treated in an inpatient environment where their safety can be the top priority.